| NPI | 1023508645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.169707) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: QMHS) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2019-08-16 |